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I've been having headache issues for about three years now. They are rarely so painful that I cannot function, but they are consistent and can last three to five days straight. I usually get two episodes per month. The pain is dull and constant, behind one eye or the other. This is accompanied by shakiness, nausea, and sometimes minor diarrhea. I was diagnosed 15 years ago with exertion-related migraine, which went away many years ago. This new thing is a bit different, longer duration, but less painful. The trigger seems to be stress, but I am not positive. Nor am I sure my issue is a migraine, or some other neurological disorder. Does this sound like migraine? Or something worse? What medical procedures or medications should I explore?

Your headaches sound typical for migraines. It is not uncommon for migraine triggers to change over time. In your case, exertion used to be a trigger, but now perhaps stress is the trigger. Also, migraine features (severity, duration, location, quality of pain, associated symptoms) may change over time.

I would schedule an appointment with a physician with expertise in treating headaches — usually a neurologist, but sometimes a primary care physician. A thorough history and pertinent examination should be done, after which the physician may decide whether any tests are necessary, whether you are a candidate for a daily medication to prevent headaches (prophylactic medication), and what medication(s) to prescribe for acute relief (“rescue” medication) of your headaches and the associated symptoms. There are numerous options for prophylactic and relief medications.

Last Updated: 1/7/2008

Dr. Stuart Stark is the medical director of the Neurology and Headache Treatment Center in Alexandria, Virginia.

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